Non-traumatic arteriovenous malformation of the spleen with fatal hemorrhage
Authors:
Silvia Farkašová Iannaccone 1; Daniel Farkaš 2; Marián Švajdler ml. 3; Jana Kaťuchová 4; Vlasta Vyhnálková 2; Vladimír Sihotský 5
Authors‘ workplace:
Ústav súdneho lekárstva UPJŠ LF, Košice
1; Úrad pre dohľad nad zdravotnou starostlivosťou, SLaPA pracovisko, Košice
2; Šiklův ústav patologie, Univerzita Karlova Praha, Lékařská fakulta Plzeň, Bioptická laboratoř s. r. o.
Plzeň a Oddelenie patológie, Univerzitná nemocnica Louisa Pasteura, Košice
3; 1. Chirurgická klinika, UPJŠ LF, Košice
4; Klinika cievnej chirurgie, Východoslovenský ústav srdcových chorôb, Košice
5
Published in:
Čes.-slov. Patol., 52, 2016, No. 2, p. 107-111
Category:
Original Article
Overview
From the medical point of view, splenic rupture developed either as a result of traumatic injury or as a result of any type of splenic disease represents a very severe and life-threatening condition. We describe the case of a 65-year old man without any obvious traumatic injury who was hospitalised because of left abdominal pain. Investigations performed at admission to the hospital (RTG, USG) failed to indicate any signs of intraabdominal bleeding. However, the patient died suddenly after 24 hours of hospitalisation. At autopsy massive intraabdominal bleeding was found. It was caused by rupture of splenic intraparenchymal hematoma developed as a result of an arteriovenous malformation in the lower pole of the spleen. This case shows the necessity of knowledge of all circumstances of death as well as the necessity of consistent histological investigation of the spleen in such cases.
Keywords:
splenic rupture – intraparenchymatous hematoma – splenic arteriovenous malformation – delayed splenic rupture
Sources
1. Povýšil C, Šteiner I et al. Speciální patologie (2 vyd). Galén Karolinum; 2007: 88.
2. DiMaio VJ, DiMaio D. Forensic Pathology (2nd edn). CRC Press Florida; 2001: 135.
3. Rinderknecht AS, Pomerantz WJ. Spontaneous splenic rupture in infectious mononucleosis: case report and review of the literature. Pediatr Emerg Care 2012; 28(12): 1377-1379.
4. Cecchetto G, Viel G, Cecchetto A, Kusstatscher S, Montisci M. Fatal splenic rupture following Heimlich maneuver: case report and literature review. Am J Forensic Med Pathol 2011; 32(2): 169-171.
5. Leff D, Nortley M, Melly L, Bhutiani RP. Ruptured spleen following laparoscopic cholecystectomy. JSLS 2007; 11(1): 157-160.
6. Abunnaja S, Panait L, Palesty JA, Macaron S. Laparoscopic splenectomy for traumatic splenic injury after screening colonoscopy. Case Rep Gastroenterol 2012; 6(3): 624-628.
7. van Buijtenen JM, Lamme B, Hesselink EJ. Spontaneous splenic rupture during Pringle maneuver in liver surgery World J Hepatol 2010; 2(6): 243-245.
8. Zyromski NJ, Camp CM. Splenic injury: a rare complication of endoscopic retrograde cholangiopancreatography. Am Surg 2004; 70(8): 737-739.
9. Weaver H, Kumar V, Spencer K, Maatouk M, Malik S. Spontaneous splenic rupture: A rare life-threatening condition; Diagnosed early and managed successfully Am J Case Rep 2013; 14: 13–15.
10. Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review BMC Emergency Medicine 2012; 12: 11.
11. Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D. Rubin´s Pathology, clinicopathologic foundations of medicine (4th edn), Lippincott 2005: 1435.
12. Iqbal M, Rossoff L, Steinberg H, Marzouk K, Siegel D. Pulmonary arteriovenous malformations: a clinical review Postgrad Med J 2000; 76(897): 390–394.
13. White RI Jr, Pollak JS, Wirth JA. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Interv Radiol 1996; 7(6): 787-804.
14. Kokaine L, Lemanis A, Sapovalovs S, Abolins A, Balodis A. Torsion of Arteriovenous Malformation – A Rare Case of Acute Abdomen. American Journal of Medical Case Reports 2014; 2(11): 229-231.
15. Khan MI, Baqai MT, Baqai MF, Mufti N. Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM) of stomach and spleen: a case report World J Emerg Surg 2009; 4: 15.
16. Cavett CM, Selby JH, Hamilton JL, Williamson JW. Arteriovenous malformation in chronic gastrointestinal bleeding. Ann Surg 1977; 185(1): 116–121.
17. Emanuel RB, Weiser MM, Shenoy SS, Satchidanand SK, Asirwatham J. Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding. J Clin Gastroenterol 1985; 7(3): 237-246.
18. Dupuis-Girod S, Bailly S, Plauchu H. “Hereditary hemorrhagic telangiectasia (HHT): from molecular biology to patient care”. J Thromb Haemost 2010; 8(7): 1447–1456.
19. De Cillis E, Burdi N, Bortone AS, et al. Endovascular treatment of pulmonary and cerebral arteriovenous malformations in patients affected by hereditary haemorrhagic teleangiectasia. Curr Pharm Des 2006;12(10): 1243-1248.
20. Sternberg SS. Histology for pathologist. Second Edition. Lippincott-Raven. Philadephia; 1997: 676.
21. Dettmeyer RB. Forensic Histopathology. Springer: Berlin Heidelberg; 2011: 176.
22. Leestma JE. Forensic neuropathology (2nd edn). Boca Raton Florida CRC Press; 2009: 509.
23. Durdík Š. Význam poznania patomorfológie sleziny v kontexte chirurgickej liečby ochorení a traumy sleziny. Univerzita Komenského: Bratislava; 2012: 22-23.
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
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